Citation Nr: 0633885
Decision Date: 11/02/06 Archive Date: 11/16/06
DOCKET NO. 04-12 197 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in San Diego,
California
THE ISSUE
Entitlement to service connection for bilateral carpal tunnel
syndrome.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
N. T. Werner, Counsel
INTRODUCTION
The veteran served on active duty from May 1965 to July 1988.
This matter comes before the Board of Veterans' Appeals
(Board) from a November 2002 decision by the Department of
Veterans Affairs (VA) Regional Office (RO) in San Diego,
California.
The appeal is REMANDED to the RO via the Appeals Management
Center (AMC), in Washington, DC. VA will notify the
appellant if further action is required.
REMAND
The veteran contends, in essence, that his bilateral carpal
tunnel syndrome was caused by his duties as a machinist over
a more than 20 year period of time while on active duty. His
DD Form 214s starting in 1968 confirm his occupational
specialty as submarine repairman. The post-service medical
evidence of record includes a Naval Medical Center nerve
conduction study and electromyography (EMG), which resulted
in a diagnosis of bilateral carpal tunnel syndrome in
December 2002. The record also indicates that the veteran
worked as a mechanic after service.
In view of the foregoing, the Board finds that there is a
duty to provide the veteran with a VA examination that
includes an opinion addressing the question of whether his
carpal tunnel syndrome is linked to his in-service duties as
a mechanic. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R.
§ 3.159(c)(4) (2006).
At a December 2003 Decision Review Officer (DRO) conference
the veteran reported that he first started to receive
treatment for his carpal tunnel syndrome following his 1988
separation from military service in approximately 2001 and
this treatment was rendered at the Balboa Naval Medical
Center. He also reported he received physical therapy at the
La Jolla VA Medical Center in approximately 2002. A review
of the treatment records from both of these facilities are
negative for any findings relating to carpal tunnel syndrome
prior to December 2002. Therefore, on remand, the RO should
obtain and associate with the record any outstanding post-
July 2001 records of the veteran's from these facilities.
38 U.S.C.A. § 5103A(b) (West 2002); 38 C.F.R. § 3.159(c)(2).
The veteran should also be notified that the record is devoid
of any relevant medical records for the first 14 years
following his separation from military service. He should be
requested to file with VA the names and addresses of any
healthcare professionals that provided him with treatment for
carpal tunnel syndrome during this time. The AMC/RO should
secure all identified medical records. 38 U.S.C.A.
§ 5103A(b); 38 C.F.R. § 3.159(c)(1)(2) (2006).
Accordingly, the appeal is REMANDED to the Appeals Management
Center (AMC) or the RO for the following actions:
1. The AMC/RO should contact the veteran
and notify him that the record is devoid
of any relevant medical records for the
first 14 years following his separation
from military service. He should be
invited to file with VA the names and
addresses of all healthcare professionals
that provided him with treatment for
carpal tunnel syndrome during this time.
The AMC/RO should secure all identified
medical records.
2. After obtaining any needed
authorizations, the AMC/RO should obtain
and associate with the claim's file all
of the veteran's post-July 1988 treatment
records that have not already been
associated with the record from all newly
identified locations, to include any
post-2001 treatment records from the
Balboa Naval Medical Center and the La
Jolla VA Medical Center that may be
available.
As to all Federal records, if they cannot
be located or no such records exist, the
veteran should be notified in writing and
a memorandum of unavailability should be
associated with the claim's file. As to
all other records, if they cannot be
located or no such records exist, the
veteran should be notified in writing.
3. After undertaking the above
development to the extent possible, the
AMC/RO should make arrangements with an
appropriate VA medical facility for the
veteran to be afforded a VA neurological
examination for the purpose of
determining the approximate onset date or
etiology of his carpal tunnel syndrome.
The claim's folder is to be provided to
the examiner for review in conjunction
with the examination. All indicated
tests and studies deemed appropriate by
the examiner must be accomplished and all
clinical findings should be reported in
detail. Thereafter, the examiner should
provide an opinion as to the following:
Is it is at least as likely as not
(i.e., 50 percent or greater
probability) that the veteran's
carpal tunnel syndrome in either
upper extremity began during service
or as the result of his duties as a
mechanic over a greater than 20 year
period of active duty?
In providing the above opinions, the
physician should take into account the
veteran's in-service and post-service
work history.
The physician is advised that the term
"as likely as not" does not mean within
the realm of possibility. Rather, it
means that the weight of medical evidence
both for and against a conclusion is so
evenly divided that it is medically sound
to find in favor of causation as to find
against causation. More likely and as
likely support the contended causal
relationship; less likely weighs against
the claim.
The examiner is also requested to provide
a rationale for any opinion expressed and
is advised that if a conclusion cannot be
reached without resort to speculation, he
or she should so indicate in the
examination report.
4. Then, after completion of any other
notice or development indicated by the
state of the record, with consideration
of all evidence added to the record
subsequent to the SOC, the AMC/RO must
readjudicate the veteran's claim. If the
claim remains denied, the AMC/RO should
issue an appropriate SSOC and provide an
opportunity to respond.
The appellant has the right to submit additional evidence and
argument on the matter or matters the Board has remanded.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
This claim must be afforded expeditious treatment. The law
requires that all claims that are remanded by the Board or by
the Court for additional development or other appropriate
action must be handled in an expeditious manner. See 38
U.S.C.A. §§ 5109B, 7112 (West Supp. 2005).
_________________________________________________
R. F. Williams
Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board is appealable to the Court. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2006).